近期皮质下小梗死患者眼底脉络膜厚度与脑白质高信号的相关性研究

Correlation between choroidal thickness and WMH in patients with recent small subcortical infarct based on optical coherence tomography

目的 探讨近期皮质下小梗死(recent small subcortical infarct, RSSI)患者脉络膜厚度与脑白质高信号(white matter hyperintensities, WMH)的关系。方法 回顾性纳入2021年11月至2023年5月常州市第二人民医院神经内科住院的RSSI患者83例,根据脑室旁白质高信号(periventricular white matter hyperintensity, PWMH)分为无-轻度1组46例,中重度1组37例;又根据深部白质高信号(deep subcortical white matter hyperintensities, DWMH)分为无-轻度2组40例,中重度2组43例。所有患者行头颅磁共振成像、光学相干断层成像检查。利用软件半自动分割脉络膜并测量厚度,按照WMH部位分为PWMH及DWMH,分析脉络膜厚度与不同部位WMH的关系。结果 中重度2组年龄、吸烟、高血压、DWMH体积明显高于无-轻度2组,脉络膜厚度明显薄于无-轻度2组,差异有统计学意义(P<0.05,P<0.01)。中重度1组年龄、吸烟、高血压、PWMH体积明显高于无-轻度1组,差异有统计学意义(P<0.05,P<0.01)。多因素logistic回归分析显示,年龄(OR=1.170,95%CI:1.064~1.287,P=0.001)、高血压(OR=4.533,95%CI:1.215~16.914,P=0.024)、脉络膜厚度(OR=0.953,95%CI:0.931~0.975,P=0.001)是DWMH等级的独立危险因素。结论 RSSI患者脉络膜厚度变化是DWMH病变程度的独立影响因素。DWMH病变越严重,脉络膜厚度越薄。

Objective To investigate the relationship between choroidal thickness and white matter hyperintensity(WMH) in patients with recent subcortical small infarct(RSSI).Methods A total of 83 RSSI patients hospitalized in our hospital from November 2021 to May 2023 were enrolled, and according to paraventricular WMH,they were divided into no to mild lesion group 1(46 cases) and moderate to severe lesion group 1(37 cases),and based on deep WMH,40 of them were assigned into no to mild lesion group 2 and 43 cases into moderate to severe lesion group 2.All patients underwent cranial MRI for paraventricular WMH and deep WMH,and optical coherence tomography to measure choroid thickness by semi-automatic segmentation.The relationship between choroidal thickness and WMH at paraventricular and deep parts was analyzed.Results Significant advanced age, higher proportions of smoking and hypertension, and larger volume of deep WMH,while obviously thinner choroid thickness were observed in the moderate to severe lesion group 2 than the no to mild lesion group 2(P<0.05,P<0.01).While the moderate to severe lesion group 1 had older age, higher smoking and hypertension ratios, and higher volume of paraventricular WMH when compared with the no to mild group 1(P<0.05,P<0.01).Multivariate logistic regression analysis showed that age(OR=1.170,95%CI:1.064-1.287,P=0.001),hypertension(OR=4.533,95%CI:1.215-16.914,P=0.024),and choroidal thickness(OR=0.953,95%CI:0.931-0.975,P=0.001) were independent risk factors for deep WMH grade.Conclusion Changes in choroidal thickness in RSSI patients are independent influencing factors for severity of deep WMH lesions.The more severe the deep WMH lesion is, the thinner the choroidal thickness.